Drowned in a sea of prescriptions

NEW YORK TIMES

February 2, 2013Updated: February 3, 2013 9:32am

Photo: COURTESY OF THE FEE FAMILY, HO

An undated handout photo of Richard Fee at graduation. The 2011 suicide of Richard Fee highlights issues in the diagnosis and treatment of ADHD, as growing numbers of youths fake symptoms to obtain steady prescriptions for stimulants that carry serious psychological dangers. (Courtesy of the Fee family via The New York Times) -- NO SALES; FOR EDITORIAL USE ONLY WITH STORY SLUGGED STIMULANTS ADDICTION BY ALAN SCHWARZ. ALL OTHER USE PROHIBITED.

An undated handout photo of Richard Fee at graduation. The 2011...

VIRGINIA BEACH, Va. - Every morning on her way to work, Kathy Fee holds her breath as she drives past the squat brick building that houses Dominion Psychiatric Associates.

It was there that her son, Richard, visited a doctor and received prescriptions for Adderall, an amphetamine-based medication for attention deficit hyperactivity disorder.

It was in the parking lot that she insisted to Richard that he did not have ADHD, not as a child and not now as a 24-year-old college graduate, and that he was getting dangerously addicted to the medication. It was inside the building that her husband, Rick, implored their son's doctor to stop prescribing him Adderall, warning, "You're going to kill him."

It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall. He hanged himself in his bedroom closet two weeks after they expired.

Faking symptoms

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The story of Richard Fee, an athletic, personable college class president and aspiring medical student, highlights widespread failings in the system through which 5 million Americans take medication for ADHD, doctors and other experts contend.

Medications such as Adderall can markedly improve the lives of children and others with the disorder. But the tunnel-like focus the medicines provide has led growing numbers of teenagers and young adults to fake symptoms to obtain steady prescriptions for highly addictive medications that carry serious psychological dangers.

These efforts are facilitated by a segment of doctors who skip established diagnostic procedures, renew prescriptions reflexively and spend too little time with patients to monitor side effects.

Richard Fee's experience included it all. Conversations with friends, family members and a review of detailed medical records depict an intelligent and articulate young man lying to doctor after doctor, physicians issuing hasty diagnoses, and psychiatrists continuing to prescribe medication - even increasing dosages - despite evidence of his growing addiction and psychiatric breakdown.

Very few people who misuse stimulants devolve into psychotic or suicidal addicts. But even one of Richard's own physicians, Dr. Charles Parker, characterized his case as a virtual textbook for ways that ADHD practices can fail patients, particularly young adults.

"We have a significant travesty being done in this country with how the diagnosis is being made and the meds are being administered," said Parker, a psychiatrist in Virginia Beach.

Young adults are by far the fastest-growing segment of people taking ADHD medications. Nearly 14 million monthly prescriptions for the condition were written for Americans ages 20 to 39 in 2011, two and a half times the 5.6 million just four years before, according to the data company IMS Health.

Stimulants easy to get

While this rise is generally attributed to the maturing of adolescents who have ADHD into young adults - combined with a greater recognition of adult ADHD in general - many experts caution that savvy college graduates can legally and easily obtain stimulant prescriptions from obliging doctors.

Richard began acting strangely soon after moving back home in late 2009, his parents said. He stayed up for days at a time, went from gregarious to grumpy and back, and scrawled compulsively in notebooks. His father, while trying to add Richard to his health insurance policy, learned that his son was taking Vyvanse for ADHD.

Richard explained to him that he had been having trouble concentrating while studying for medical school entrance exams the previous year, and that he had seen a doctor and received a diagnosis.

His father reacted with surprise. Richard had never shown any ADHD symptoms his entire life, from nursery school through high school, when he was awarded a full academic scholarship to Greensboro College in North Carolina. Rick Fee also expressed concerns about the safety of his son taking daily amphetamines for a condition he might not have.

"The doctor wouldn't give me anything that's bad for me," Rick Fee recalled his son saying that day. "I'm not buying it on the street corner."

Richard's first experience with ADHD pills, like so many others', had come in college. Friends said he was a typical undergraduate user - when he needed to finish a paper or cram for exams, one Adderall would jolt him with focus and purpose for six to eight hours, repeat as necessary.

So many fellow students had prescriptions or stashes to share, friends of Richard recalled in interviews, that guessing where he got his was futile. He was popular enough on campus - he was sophomore class president and played first base on the baseball team - that they doubted he even had to pay the typical $5 or $10 per pill.

"He would just procrastinate, wait till the last minute and then take a pill to study for tests," said Ryan Sykes, a friend. "It got to the point where he'd say he couldn't get anything done if he didn't have the Adderall."

Highly addictive

Various studies have estimated that 8 percent to 35 percent of college students take stimulant pills to enhance their school performance.

Few students realize that giving or accepting even one Adderall pill from a friend with a prescription is a federal crime.

The Drug Enforcement Administration classifies Adderall and its stimulant siblings as Schedule II drugs, in the same category as cocaine, because of their highly addictive properties.

Friends and former baseball teammates flocked to Richard Fee's memorial service in Virginia Beach in 2011. Most remembered only the funny and gregarious guy they knew in high school and college; many knew nothing of his last two years. He left no note explaining his suicide.

At a gathering at the Fees' house afterward, Rick Fee told them about Richard's addiction to Adderall. Many recalled how they, too, had blithely abused the drug in college - to cram, just like Richard had - and could not help but wonder if they had played the same game of Russian roulette.